POEMs

Is Acupuncture Effective for Chronic Headache?

Clinical Question: Is acupuncture an effective therapy in patients with chronic head-ache, including migraine?

Setting: Outpatient (primary care)

Study Design: Randomized controlled trial (nonblinded)

Synopsis: Using standard criteria of the International Headache Society, researchers identified patients from general practices in England who had migraine (most of them) or tension headache. The 401 adults had at least two headaches per month, although the average number of days with headache was 16 per month. Patients participated in a one-month run-in period to determine if they could complete a headache diary. Following this initial period, the patients were randomized (using concealed allocation) to receive usual treatment from their primary care physicians (who were asked to avoid acupuncture) or to receive up to 12 acupuncture treatments over three months from qualified acupuncturists. The method of acupuncture was determined by the health care professional.

Patients kept a daily diary of headache and medication use during months 3 and 13 after randomization. The researchers asked patients to score the severity of their head-aches from zero (no headache) to 5 (intense headache) four times a day, totaling the score for each week (maximum score = 140).

After one year, headache scores in the acupuncture group decreased by 34 percent from baseline (from 24.6 to 16.2), while scores in the usual-treatment group decreased by only 16 percent (from 26.7 to 22.3). Patients treated with acupuncture experienced 22 fewer days of headache per year (standard deviation = eight to 38), on average. Using a 35 percent decrease as a clinically significant reduction in headache, 22 percent more acupuncture patients improved than usual-care patients (number needed to treat = 4.6; 95 percent confidence interval, 3.0 to 9.0).

Bottom Line: Acupuncture treatment of patients with frequent headache, especially migraine, is more effective than usual care in decreasing headache severity scores and the number of days with headache. (Level of Evidence: 2b)